中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2008年
7期
409-412
,共4页
时启标%张福香%王桂娥%姜凤珍%徐由锁%黄霞
時啟標%張福香%王桂娥%薑鳳珍%徐由鎖%黃霞
시계표%장복향%왕계아%강봉진%서유쇄%황하
心肺复苏%肾上腺素%递增剂量%方程%氨茶碱
心肺複囌%腎上腺素%遞增劑量%方程%氨茶堿
심폐복소%신상선소%체증제량%방정%안다감
cardiopulmonary resuscitation%epinephrine%graduate increased dosage%equation
目的 探讨肾上腺素递增剂量方程G=(K+2n-1)mg/3 min(K=1、2,n=1、2……5,G≤0.2 mg/kg)与氨茶碱快速同步联合在心肺复苏(CPR)中的应用效果及临床价值.方法 将376例心搏骤停患者随机分成3组.采用肘静脉通道分别静脉推注(静推)给药:①对照组(130例):首次静推肾上腺素1 mg,若无效则每隔3 min重复首次剂量.②方程中首剂量K=1 mg为方程1组(122例);K=2 mg为方程2组(124例).方程1组首次静推肾上腺素1 mg和氨茶碱7 mg/kg,若无效则每隔3 min按方程计算出的肾上腺素递增剂量以2、3……17 mg和氨茶碱7 mg/kg快速同步静推1次;方程2组首次静推肾上腺素2 mg和氨茶碱7 mg/kg,若无效则每3 min按方程计算出的肾上腺素递增剂量以3、4……18 mg和氨茶碱7 mg/kg快速同步静推1次.当肾上腺素递增剂量超过0.2 mg/kg时则停药.监测各组心电、平均动脉压(MAP)、心率(HR)、自主循环恢复(+ROSC)的时间,并进行复苏效果评价.结果 ①方程2组和方程1组+ROSC率(91.13%,88.52%)、24 h存活率(85.48%,67.21%)、出院存活率(49.19%,31.15%)、存活出院者格拉斯哥昏迷评分[GCS,(13.12±1.27)分,(12.28±1.32)分]均较对照组[26.92%、25.39%、12.31%、(9.08±1.13)分]显著升高(P均＜0.01),CPR开始用药至+ROSC时间[(8.93±3.27)min、(8.25±5.25)min]较对照组((39.25±9.75)min]显著缩短(P＜0.01).②方程2组和方程1组从CPR开始至+ROSC所用肾上腺素量较对照组明显减少[(11.75±3.25)mg、(13.85±5.15)mg比(24.65±4.35)mg,P均＜0.05],两组达到+ROSC所需静推肾上腺素次数也较对照组显著减少[(3.45±0.55)次、(3.85±0.75)次比(18.25±0.75)次,P均＜0.01].结论 采用肾上腺索递增剂量方程和氨茶碱7 mg/kg快速同步联合应用,在CPR流程中能显著提高+ROSC率和存活率,显著缩短ROSC时间,明显改善神经功能,提高复苏时的效应.
目的 探討腎上腺素遞增劑量方程G=(K+2n-1)mg/3 min(K=1、2,n=1、2……5,G≤0.2 mg/kg)與氨茶堿快速同步聯閤在心肺複囌(CPR)中的應用效果及臨床價值.方法 將376例心搏驟停患者隨機分成3組.採用肘靜脈通道分彆靜脈推註(靜推)給藥:①對照組(130例):首次靜推腎上腺素1 mg,若無效則每隔3 min重複首次劑量.②方程中首劑量K=1 mg為方程1組(122例);K=2 mg為方程2組(124例).方程1組首次靜推腎上腺素1 mg和氨茶堿7 mg/kg,若無效則每隔3 min按方程計算齣的腎上腺素遞增劑量以2、3……17 mg和氨茶堿7 mg/kg快速同步靜推1次;方程2組首次靜推腎上腺素2 mg和氨茶堿7 mg/kg,若無效則每3 min按方程計算齣的腎上腺素遞增劑量以3、4……18 mg和氨茶堿7 mg/kg快速同步靜推1次.噹腎上腺素遞增劑量超過0.2 mg/kg時則停藥.鑑測各組心電、平均動脈壓(MAP)、心率(HR)、自主循環恢複(+ROSC)的時間,併進行複囌效果評價.結果 ①方程2組和方程1組+ROSC率(91.13%,88.52%)、24 h存活率(85.48%,67.21%)、齣院存活率(49.19%,31.15%)、存活齣院者格拉斯哥昏迷評分[GCS,(13.12±1.27)分,(12.28±1.32)分]均較對照組[26.92%、25.39%、12.31%、(9.08±1.13)分]顯著升高(P均＜0.01),CPR開始用藥至+ROSC時間[(8.93±3.27)min、(8.25±5.25)min]較對照組((39.25±9.75)min]顯著縮短(P＜0.01).②方程2組和方程1組從CPR開始至+ROSC所用腎上腺素量較對照組明顯減少[(11.75±3.25)mg、(13.85±5.15)mg比(24.65±4.35)mg,P均＜0.05],兩組達到+ROSC所需靜推腎上腺素次數也較對照組顯著減少[(3.45±0.55)次、(3.85±0.75)次比(18.25±0.75)次,P均＜0.01].結論 採用腎上腺索遞增劑量方程和氨茶堿7 mg/kg快速同步聯閤應用,在CPR流程中能顯著提高+ROSC率和存活率,顯著縮短ROSC時間,明顯改善神經功能,提高複囌時的效應.
목적 탐토신상선소체증제량방정G=(K+2n-1)mg/3 min(K=1、2,n=1、2……5,G≤0.2 mg/kg)여안다감쾌속동보연합재심폐복소(CPR)중적응용효과급림상개치.방법 장376례심박취정환자수궤분성3조.채용주정맥통도분별정맥추주(정추)급약:①대조조(130례):수차정추신상선소1 mg,약무효칙매격3 min중복수차제량.②방정중수제량K=1 mg위방정1조(122례);K=2 mg위방정2조(124례).방정1조수차정추신상선소1 mg화안다감7 mg/kg,약무효칙매격3 min안방정계산출적신상선소체증제량이2、3……17 mg화안다감7 mg/kg쾌속동보정추1차;방정2조수차정추신상선소2 mg화안다감7 mg/kg,약무효칙매3 min안방정계산출적신상선소체증제량이3、4……18 mg화안다감7 mg/kg쾌속동보정추1차.당신상선소체증제량초과0.2 mg/kg시칙정약.감측각조심전、평균동맥압(MAP)、심솔(HR)、자주순배회복(+ROSC)적시간,병진행복소효과평개.결과 ①방정2조화방정1조+ROSC솔(91.13%,88.52%)、24 h존활솔(85.48%,67.21%)、출원존활솔(49.19%,31.15%)、존활출원자격랍사가혼미평분[GCS,(13.12±1.27)분,(12.28±1.32)분]균교대조조[26.92%、25.39%、12.31%、(9.08±1.13)분]현저승고(P균＜0.01),CPR개시용약지+ROSC시간[(8.93±3.27)min、(8.25±5.25)min]교대조조((39.25±9.75)min]현저축단(P＜0.01).②방정2조화방정1조종CPR개시지+ROSC소용신상선소량교대조조명현감소[(11.75±3.25)mg、(13.85±5.15)mg비(24.65±4.35)mg,P균＜0.05],량조체도+ROSC소수정추신상선소차수야교대조조현저감소[(3.45±0.55)차、(3.85±0.75)차비(18.25±0.75)차,P균＜0.01].결론 채용신상선색체증제량방정화안다감7 mg/kg쾌속동보연합응용,재CPR류정중능현저제고+ROSC솔화존활솔,현저축단ROSC시간,명현개선신경공능,제고복소시적효응.
Objective To investigate the effect of application and clinical value of use of epinephrine in graduate increased dosage according to the equation G = (K + 2<'n-1>)mg/3 minutes (K = 1, 2, n = 1, 2……5,G≤0.2 mg/kg ) combined with aminophyline in cardiopulmonary resuscitation (CPR). Methods Three hundred and seventy-six patients with sudden cardiacarrest (CA) were randomly divided into 3 groups. Epinephrine and aminophyline were given through cubital vein with following methods: @ Control:(n=130). 1 mg of adrenaline was given as the first treatment. Repeat the same every 3 minutes if there was no effect. ② In one hundred and thirty cases, the first dose of epinephrine was K = 1 mg (n = 122),K=2 mg (n=124). In K=1 mg group,epinephrine 1 mg and aminophyline 7 mg/kg were given as the first dose. If it was not effective, increasing dosage of epinephrine in order of 2, 3……17 mg and aminophrine 7 mg/kg was given intravenously successively every 3 minutes (K = 1, 2, n= 1, 2……5). In group 2 (group equation 2), eqinephrine 2 mg and aminophyline 7 mg/kg were given rapidly intravenously. If not effective,the drugs were repeated according to the equation intravenously every 3 minutes. When the dose of epimephrine exceeded 0. 2 mg/kg, it should be stopped. Electrocadiogram, mean arterial pressure (MAP),the heart rate (HR), and the time of recovery of spontaneous circulation (+ROSC) were monitored, and they were evaluated for the effectiveness of resuscitation. Results ①+ROSC rate (91.13%, 88.52%), the 24-hour survival rate (85.48%, 67.21%), the survival rate (49.19%, 31.15%), and the Glasgow coma scores ((13.12±1.27)scores, (12.28±1.32) scores] were all significantly elevated in groups in which patients received the modified regime compared with the control group [26.92%, 25.39%, 12.31% and (9.08±1.13)scores, all P＜0.01]. The average time for + ROSC in the equation 2 and 1 groups was (8.93±3.27) minutes and (8.25±5.25) minutes, respectively, and they were significantly shorter than those of the control group [(39.25+9.75) minutes, both P＜0.01]. ② The average dose of the epinephrine was much reduced in achieving +ROSC in two groups with modified regimes as compared with control group [(11.75±3.25) mg and (13.85+5.15) mg, respectively vs. (24.65+4.35) mg, both P＜0.05], and the number of using application epinephrine via intravenous from the CPR initial stage to +ROSC in the equation 2 and 1 groups was much significantly decreased compared with the control group [(3.45+0.55) times and (3.85±0.75) times vs. (18.25±0.75) times, both P＜0.01]. Conclusion The newly formed regime has better effects in increasing significantly the success rate of cardiac-resucitation, the survival rate, and it also shortens the time for successful recovery of spontaneous circulation. It can improve the recovery of brain and nervous system function.
